Dickinson, John 01.30.2018AFFIDAVIT
TATE OF TEXAS )(
,,OUNTY OF WICHITA )( r
a member of the ZM,&t#eA make this affidavit and hereby on oath
state the following: I and/or a person or persons related to me, have a substantial interest in a
business entity that would be peculiarly affected by a vote or decision of the L�?LLFJ�u'f�
C��u�G1.� St�tlLl, as those terms are defined in Chapter 171 of The Texas Local Government Code.
Date of Meeting: �v r� Item No.
The business entity is .� ZG' �— l L/?`�
I (have/has) a substantial interest in this business entity for the following reasons: (Check all which
are applicable.)
'� Ownership of 10% or more of the voting or shares of the business entity.
Ownership of $5,000 or more of the fair market value of the business entity.
Funds received from the business entity exceed 10% of his/her income for the previous year.
Real property is involved and his/her has an equitable or legal ownership with a fair market
value of at least $2,500.
A relative of mine has a substantial interest in the business entity or property that would be
affected by a decision of the public body of which I am a member.
Upon the filing of this affidavit with the City Clerk„ I affirm that I will abstain from voting on any
decision involving this business entity and from any further participation on this matter whatsoever.
Signed this 36 day o20
Signature of Official
1%l ��/��
Title
BEFORE ME, the undersigned authority, this day personally appeared J a h n D, ( IL „. �/i„
and on oath stated that the facts hereinabove stated are true to the best of his/her knowledge and
belief.
Sworn to and subscribed before me on this the �,b F day of )awau- U , 20
KIA BOONE
My Notary ID # 131047080
My Commission Expires: Expires March15,2021 (/(/
Atary Publioelin and for the
(I')aState of Texas
FIECEIVEu IN
CITY CLERK'S OFFICE
DATE' ---
TIME: - Q". v7 Pr"